Newer techniques of sterilization & contraception ,injectable contraceptives &emergency contraceptives

1. Newer techniques of sterilization &
contraception ,injectable contraceptives
&emergency contraceptives
by Dr.surendra babu (pg 1st yr)
Moderator: Dr.Prof, O.P. Panigrahi

2. RISUG (Reversible Inhibition of Sperm Under Guidance)
• A local anaesthetic is applied to the scrotum at the injection site.
• The vas deferens—the tube that sperm pass through on their way from the
testes to the penis—is extracted through the scrotum and injected with a
polymer made from styrene maleic anhydride (SMA) and dimethyl sulfoxide
(DMSO).
• On the market, this non-toxic polymer is known as Vasalge. The process is then
repeated on the other side with the second vas deferens

3. Adiana sterilization system :
• A clinician delivers a catheter through a hysteroscope into the fallopian tube &
uses the cathter to apply low level radio frequency energy ,followed by an
insertion of a matrix (polymer implant,smaller than grain of rice )
• The matrix is left in the fallopian tube and the surrounding tissue will grow into it
causing permanent blockage
• Failure rate :0.2 per 100 women years
• US FDA approval recently

4. ESSURE :
• The Essure is a permanent birth control (female sterilization) by, an occlusion of
the fallopian tubes with the use of trans-cervical bilateral insertion of blocking
coils directly into the lumen of the tubes
• . The device itself is made from dual coils that expand into the tubal lumen when
deployed. Its fibers stimulate occlusive tissue growth over a 3 month period.
• Successful placement and tubal occlusion is confirmed by hysterosalpingography
• It is irreversible Removal of the micro-inserts requires surgery. Its hould not be
considered 100% effective.

5. Approved by FDA in 2002

6. Advantages :
• No incision
• No hormones
• No anaesthesia
• outpatient
• Effective
The one-year and two-year failure rates established in the Essure clinical trials
were both 0%.
• Rapid recovery
• High patient satisfaction

7. Complications :
• Complications include device expulsion, tubal perforation, and
pregnancy.
• Unlike laparoscopic sterilization, it is not immediately effective

8. • The highly charged polymer attaches to the inner walls of the vas deferens, and
when it comes in contact with the negatively charged sperm, ruptures their tails so
that they are incapable of fertilizing eggs
• This is what separates RISUG from a vasectomy—sperm can still be expelled
from the scrotum, but cannot reach and fertilize an egg
• The procedure typically lasts no more than a few minutes
• The reversal process is also simple, with a quick injection of water and baking
soda to flush out the Vasalgel.
• The side effects of the procedure are minimal, and may including swelling at the
injection site.

9. What’s New in Contraception?
Factors to consider:
• Innovative methods
• Longer term
• Reduced dosing
• Reduced risks
• Quick reversibility
• Equally as effective as OCP
• Less reliant on the user

10. Methods of Contraception
Methods of Contraception
I. Combined
Hormonal
Oral contraceptive pills
Depot medroxyprogesterone acetate injections
Transdermal patches and Vaginal rings,
II. Barrier
and
Behavioral
Male condoms, Diaphragms
Caps, Female condoms, Spermicides
Withdrawal, Fertility awareness method,
Natural family planning
III. Longer Term
Progestin implants and Intrauterine devices
IV. Sterilization Female sterilization and Vasectomy

11. What’s new?
 Contraceptive patch ( Ortho Evra )
 Vaginal ring ( Nuvaring )
Intrauterine system ( Mirena )
 Progestogen-only Implants ( Implanon )
Transcervical sterilization methods
Yasmin Seasonale
Male contraceptive method

12. Transdermal patch :

13. It is a beige-colored patch applied once a week to the abdomen,
buttock, upper outer arm, or upper torso (excluding breasts).
The patch releases 150 mcg of norelgestromin and 20 mcg of ethinyl
estradiol to the bloodstream daily to inhibit ovulation.
3 consecutive 7-day patches (21 days) are applied, followed by 1
patch-free week per cycle. The patch contains 9 days of medication.

14. Advantages:
 Very effective
 Rapidly reversible
 Excellent cycle control by 3 months of use
 Easy to use, start, and stop
 Extra protection built in; serum hormone levels will remain in the contraceptive
range for up to 2 additional days
Disadvantages:
 Requires a prescription
 Concern about visibility of patch for some women
 Possible skin reactions
 Slight increase in risk of VTE compared with COCs
 Lack of protection against STIs

15. Vaginal ring (nuva ring )

16.  Vaginal ring is a thin, transparent, flexible ring that contains
oestrogen/progestogen hormones that are absorbed through vaginal mucosa.
 The ring is 92% to 99% effective for pregnancy prevention (typical to
perfect use).
 It stops ovulation and thickens the cervical mucus.
Worn continuously for three weeks followed by a week off, each vaginal
ring provides one month of birth control.

17. Advantages:
 Easy to use
 Can be worn for three weeks
 Effects fertility one month at a time
Disadvantages:
 Does not protect against sexually transmitted infections, including HIV/
AIDS
 Spotting
 Increased vaginal discharge

18. Adverse effects
• Vaginitis (14.1%)
• Headache (9.8%)
• URTI (8%)
• Leukorrhea (5.8%)
• Nausea (5.2%)
• Weight gain (4.9%)
• Expulsion & Coital problems (2.6%)

19. Prostogen only implant
This is a matchstick-size, flexible rod that is put under the skin of the upper arm.
• It is often called by its brand name, Implanon.
• The rod releases a progestin, which causes changes in the lining of the uterus and the
cervical mucus to keep the sperm from joining an egg.
• Less often, it stops the ovaries from releasing eggs.
Advantages :
It is affective for 3 years
Disadvantages :
• May cause side effects, including irregular bleeding. Doesn't protect against STIs.

20. Female barrier method
Female Condom

21.  A lubricated polyurethane pouch that is inserted inside the vagina during intercourse.
Advantages:
 Prevents the transmission of HIV and other STDs
 No hormonal side effects
 Can be used by people with latex sensitivities
 Does not affect future fertility
Disadvantages:
 Sometimes difficult to insert or use
 Friction/noise during intercourse
 Loss of sensation
 Can break or leak

22. Emergency contraception :
• It is a method of contraception used to prevent pregnancy ,also
known as “morning after pill” or postcoital contraception
• A woman who had an unprotected sex & want to prevent pregnancy
can use emergency contraception in following circumstances
Unprotected intercourse
Rape ,sexual assault ,incest
Failure of contraceptive method
this method can save the lady from agony & embracement of
restoring illegal abortion even suicide

25. • This method is recommended with in 48 to 72 hrs of unprotected intercourse
• They act by stopping ovulation or by interfering with implantation of the ovum
High dose
progesterone
High dose estrogens Estrogen –
progesterone
combination (yuzpe)
Content Levonorgestrel 1.5 mg
(i-pill)
One pill to be taken
preferably with in
12hrs & not later than
72 hrs & 2nd pill to be
taken witin 12 hrs
after the 1st pill
Diethylstilbestrol 50 mgm
for 5 days
Ethinyl estradiol 05mgm for
5 days
100 mgm estrogen
&1mgm progestrogen
(Mala-N & mala-D)
Failure rate < 1% 0.2 to 2%
Side effects Nausea ,vomiting
,headache & breast
Severe & high due to high
doses of estrogen
Due to high doses of
estrogen

26. Recent advances in emergency contraception :
Danazol :it is progestogen only with anti-gonadotropic activity
Mechanism of action :Prevents implantation by making unfavourable endometrium
Dose : 2 doses of 400 mgm each at 12 hrs interval
This method is more effective than yuzpe regimen
Mifepristone :(RU486 )it is anti progesterone
Mechanism of action :Prevents ovulation & hinders development of endometrium
Dose :600 mg stat with in 120 hrs
This method is more effective than yuzpe & danzol

27. Mechanical method of emergency contraception :
• This consists of insertion of cooper IUD within 3 to 5 days of unprotected
intercourse
• Mechanism of action :prevents implantation of embryo &embryo toxic effect by
cooper ions
• This is useful particularly when hormonal pills are contraindicated
• Contraindication :in woman who are at risk of STD because of rape
• This is more effective than hormonal method as emergency contraceptive

28. Method & Dose Time after Intercourse Failure rate (%) Comments
High dose estrogen
< 72 hours
Diethyl stilbestrol 50mg or
Ethinyl Estradiol 5mg X 5 days
0.3-1.6 severe nausea & vomiting,
failure to complete regimen
Yuzpe’s Regime (E+P) - Ethinyl
Estradiol 100 μg +
Levonorgestrel 0.5 m
<72 hrs., repeat after 12 hrs. O.2-3.2
(75-80% effective
risk of estrogen use
low efficacy
Danazol 800mgm X 3 doses
1200mg X 2doses
72 hrs 0.8-1.7 androgenic effect on repeated
use
IUD (CuT) 5 days <1
risk of PID, unsuitable for
nullipara,
infrastructure & training
required
Centchroman 50mg 2 tablets 72-120 hrs repeat after 12 hrs to be evaluated menstrual delay
Levonorgestrel - 0.75 mg X2
1.5 mg X 1
upto 120 hrs, 0.75mg (two
doses 12 hrs apart) or 1.5mg
(single dose)
1.1
safe & effective
cheap
Anti-Progestin RU 486
(Mifepristone) 10mg single
dose
120 hrs 1.1-1.3
menstrual delay,
risk of ectopic pregnancy

29. Injectable contraceptives :
• They are called as “depot formulations” or “slow release formulations”
• These are formulations containing only synthetic progesterone which is released
over long period of time ,thus providing long lasting hormonal contraceptive
activity
Most widely used injectables are DMPA & NET-EN

30. Injectable contraceptives :
• They are called as “depot formulations” or “slow release formulations”
• These are formulations containing only synthetic progesterone which is released
over long period of time ,thus providing long lasting hormonal contraceptive
activity
Most widely used injectables are DMPA & NET-EN
DMPA (depot medroxy progesterone
acetate)
NET-EN (norethisterone ethnalthate )
Suspension Micro crystalline suspension Oily suspension
Route of administration Deep intramuscular once in 3 months Deep intramuscular once in 2 months
Dose 150mgm of progestin (synthetic
progesterone)
200 mgm synthetic progesterone
Duration of protection 3 months 2 months
Return of fertility 4 to 6 months ,after stoppage of drugs Same

31. Merits :
• very safe ,affective ,convenient & reversible
• Does not interfere with lactation & sex
• Can be used by women of any age in the reproductive period
• Helps prevent ectopic pregnancies,endometrial cancer & uterine fibroids
Demerits :
Menstrual cycle become irregular
Weight gain 1or 2kg per year
Head ache ,breast tenderness ,mood changes
Postpartum use : if used with in 6 wks of delivery ,it may result in heavy bleeding

32. Contraindications :
• Suspected malignancy
• PID
• Bleeding disorders